From the Cardiology Division (J.H.W., C.O'B., R.W.Y.), Department of Medicine (J.H.W., C.O'B., R.W.Y., J.B.S.), and Laboratory of Computer Science (A.H.Z., J.L.), Massachusetts General Hospital, Harvard Medical School, Boston; Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., J.A.S.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (K.Z., S.-L.T.N.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); and Harvard Clinical Research Institute, Boston, MA (L.M., R.W.Y.).
Circ Cardiovasc Interv. 2014 Feb;7(1):97-103. doi: 10.1161/CIRCINTERVENTIONS.113.000988. Epub 2014 Jan 14.
Rehospitalization within 30 days after an admission for percutaneous coronary intervention (PCI) is common, costly, and a future target for Medicare penalties. Causes of readmission after PCI are largely unknown.
To illuminate the causes of PCI readmissions, patients with PCI readmitted within 30 days of discharge between 2007 and 2011 at 2 hospitals were identified, and their medical records were reviewed. Of 9288 PCIs, 9081 (97.8%) were alive at the end of the index hospitalization. Of these, 893 patients (9.8%) were readmitted within 30 days of discharge and included in the analysis. Among readmitted patients, 341 patients (38.1%) were readmitted for evaluation of recurrent chest pain or other symptoms concerning for angina, whereas 59 patients (6.6%) were readmitted for staged PCI without new symptoms. Complications of PCI accounted for 60 readmissions (6.7%). For cases in which chest pain or other symptoms concerning for angina prompted the readmission, 21 patients (6.2%) met criteria for myocardial infarction, and repeat PCI was performed in 54 patients (15.8%). The majority of chest pain patients (288; 84.4%) underwent ≥1 diagnostic imaging test, most commonly coronary angiography, and only 9 (2.6%) underwent target lesion revascularization.
After PCI, readmissions within 30 days were seldom related to PCI complications but often for recurrent chest pain. Readmissions with recurrent chest pain infrequently met criteria for myocardial infarction but were associated with high rates of diagnostic testing.
经皮冠状动脉介入治疗（PCI）后 30 天内再入院很常见，费用高昂，也是未来医疗保险罚款的目标。PCI 后再入院的原因在很大程度上尚不清楚。
为了阐明 PCI 再入院的原因，在 2 家医院确定了在 2007 年至 2011 年期间出院后 30 天内再入院的 PCI 患者，并对其病历进行了回顾。在 9288 例 PCI 中，9081 例（97.8%）在指数住院治疗结束时存活。其中，893 例（9.8%）患者在出院后 30 天内再入院，并纳入分析。在再入院患者中，341 例（38.1%）因复发胸痛或其他疑似心绞痛的症状而再次入院接受评估，59 例（6.6%）因无新症状的分期 PCI 而再次入院。PCI 并发症导致 60 例再入院（6.7%）。对于因胸痛或其他疑似心绞痛症状而再次入院的病例，21 例（6.2%）符合心肌梗死标准，并对 54 例（15.8%）患者进行了再次 PCI。大多数胸痛患者（288 例；84.4%）接受了≥1 项诊断性影像学检查，最常见的是冠状动脉造影术，只有 9 例（2.6%）接受了靶病变血运重建。
PCI 后 30 天内再入院很少与 PCI 并发症有关，但常与复发性胸痛有关。因复发性胸痛而再次入院的患者很少符合心肌梗死的标准，但与高比例的诊断性检查有关。
